Is Acetaminophen Safe to Take When You’re Drinking?

What really happens when Tylenol and alcohol mix

Contributor: Christina Lindenmeyer, MD

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There are times where festivities abound — and a few drinks later — our heads pound. Some people wonder if they’ve had alcohol, how harmful is it to also take acetaminophen, more commonly known as Tylenol®.

How does your liver process medications and alcohol?

As it does for many medications, your body metabolizes acetaminophen in the liver. When you take the recommended dosage, most of the medication is converted by your liver into a benign substance that is removed in your urine.

Your body converts a very small byproduct of metabolized acetaminophen into a toxic substance that can be harmful to your liver. Luckily, a secondary substance called glutathione helps minimize the toxic effects of acetaminophen.

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However, if you take too much acetaminophen, or if the liver does not have an abundant reserve of glutathione, the toxic metabolite can accumulate and cause significant damage to your liver.

Like acetaminophen, alcohol is also metabolized by liver cells. In fact, both acetaminophen and alcohol utilize glutathione in the liver to temper their toxic effects.

Over time, chronic, heavy alcohol intake depletes your liver of its glutathione stores, which can lead to problems when acetaminophen is added to the mix.

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Will Tylenol after a few drinks harm your liver?

Typically, isolated alcohol intake combined with a normal dose of acetaminophen (no more than 4000 mg in a day) should not cause liver damage. However, regular, heavy alcohol use (three or more drinks per day) combined with repeated daily doses of acetaminophen predisposes the liver to acetaminophen-associated toxicity.

In general, if you are going to drink at a party or other social event and you take a couple of doses of acetaminophen the next day for your headache (again, no more than 4000 mg in a day), you should be fine.

However, if you regularly drink three or alcoholic drinks per day, your liver would be best served by limiting your acetaminophen use to rare instances, avoiding daily use, and avoiding daily doses greater than 4000 mg. ​

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